Review Question - QID 109902

A 6-year-old girl of Moroccan descent is brought to the pediatrician by her father who is concerned about the child developing a body odor. He reports that she has started to smell “like a teenage boy” especially after physical activity. The child has had limited medical follow-up since being born in Morocco and immigrating to the United States at 3 years of age. Her temperature is 99°F (37.2°C), blood pressure is 150/90 mmHg, pulse is 85/min, and respirations are 18/min. On exam, she has hair in her axillary and pubic regions. Genital examination demonstrates clitoral enlargement and labioscrotal fusion. Which of the following metabolites is most likely elevated in this patient?